What is the estimated cost of patient noncompliance, abuse and fraud
in the Medicaid Program ? This is not provider fraud and abuse, but
specifically patient actions. Noncompliance would include not taking
prescriptions or otherwise not following medical instructions as well
as the social issues of smoking, drinking, drug-abuse and obesity. I
would require research and not random estimates. I do not want
disease-specific noncompliance estimates, but the total cost based on
good research and projections. I require this in anticipation of
seeking a grant to study this waste and would welcome any reference to
such grants being available. I expect that the first step would be to
determine what has already been done.

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Request for Question Clarification by czh-ga on 19 Apr 2004 19:23 PDT

Hello hcsimo-ga,

Since Medicaid is a joint federal/state program and varies from state
to state it seems unlikely that I will be able to find you research or
reports to cover national figures. Please explain further what kind of
research would qualify as a satisfactory answer to your question. Have
you already found some research that meets your needs that could serve
as an example of what you?re looking for? How much information are you
expecting for this project? The more background information and
context you can share, the more likely I will be able to get you what
you need. I look forward to your clarification.

~ czh ~

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Clarification of Question by hcsimo-ga on 20 Apr 2004 08:47 PDT

I am interested in a number for the Federal Medicaid program, but good
research by a state with sizeable Medicaid population could be
extrapolated and would be acceptable. A study that I attempted for a
state Medicaid HMO would have identified hospital admissions resulting
from patient noncompliance as the major expense from noncompliance and
unnecessary Emergency Room visits and Ambulance transport as the major
items for abuse. Patient fraud must be reported to the State when
uncovered and involves false reporting of equipment losses
(wheelchairs, oxygen equipment, etc, selling prescription drugs on the
street, lending ID cards to friends for services, etc.  I have
personally looked for such studies and I am chagrined that nobody has
ever tried to identify this waste - by patients. There are
disease-specific estimates for cost of noncompliance for total
population, but there almost seems to be reluctance to know how much
waste is patient-induced in Federal programs. They have worked the
provider fraud to death, but nothing on patient responsibility. I had
hoped for a federal grant to do such a study, but I do not trust my
humble efforts to see what has already been done. I would find
acceptable any statistically significant study that identified this
combined expense from patient waste. There should include the good
estimates of expense due to social abuses like smoking, drugs, alcohol
and obesity. Maybe I can't expect such research from this site, but I
was intrigued by the possibility and I hope this clarifies my needs. I
have also considered writing a book on the subject and would need data
if I cannot get a grant to study it myself. Feel free to ask for more
specifics - or to decline.